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Cold, Altitude Threaten Troops' Health in Afghanistan

WASHINGTON, Dec. 14, 2001  Cold and altitude are currently the most serious environmental threats to troops serving in Afghanistan. In a few months, they'll need to worry more about malaria.

Many different issues can impact service members' health while serving in Central Asia, but the most serious varies depending on the area and the season, said Army Dr. (Lt. Col.) Bruno Petruccelli. He's the epidemiology program manager with the Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Md.

"The most likely environmental or physical threats (now) would be the high altitude and the cold," Petruccelli said. "In the summer months, the heat can get pretty horrendous as well."

Tactics can make a difference in preventing health problems, such as those from cold and altitude. But, Petruccelli said, military medical professionals don't recommend changes in tactics. They give information, and it's up to commanders to weigh the risks against the importance of the mission, he explained.

"When it is possible, altitude illness is best prevented by ascending slowly," he said. Ascending slowly and spending at least one night at altitude will prevent most cases of "mountain sickness" and "make the mission go a little bit more smoothly," he said.

But physical symptoms to altitude changes can occur as low as 5,000 feet in particularly susceptible individuals, he said. And for some missions, slow ascent just isn't an option. "Sometimes we fly right into a high altitude," Petruccelli said.

Physical signs of altitude sickness include headache, dizziness, nausea and fatigue. "All things that in their mildest form may not interfere with normal functioning," Petruccelli said. "But they may predict a more serious event later on."

"A more serious event" might even include life-threatening cerebral edema, or fluid accumulating in the brain, he said. The condition's rare, he said, but physicians in the area need to be aware of possibilities.

The threat of altitude sickness declines after the first 24 to 48 hours. "After a while, our breathing adjusts and our blood cells adjust and we do fine," Petruccelli said. "But it may take a few days to get there."

Cold is easier for individuals to protect themselves against. The military has excellent cold-weather gear that can be mixed and layered depending upon weather conditions, Petruccelli said. He recommended troops use it properly.

He said it's possible to overdress and become a heat casualty even in the winter.

In the summer, some parts of Central Asia experience extremely high temperatures. Petruccelli said the best way to avoid heat injuries is to stay hydrated. He recommended sipping up to a quart or more of water over the course of each hour. Gulping large amounts of water at once is not as helpful, he said, and can even be harmful.

As early as March, the threat of malaria goes up considerably. U.S. forces deployed to areas where malaria is present take one of two types of prophylactic medication.

The anti-microbial drug mefloquine is taken once a week and must be started at least two weeks before going into the region, Petruccelli said. "It takes that long for adequate blood levels to be achieved," he said.

It also has to be taken for at least four weeks after one leaves the area in order to keep killing the parasites that emerge in the individual.

"Malaria can still emerge several weeks later. Parasites can stay in the body and start to multiply after you stop taking the drug," he explained. "The drug is a suppressant; it's not really an agent that immediately eliminates any parasite that gets into your body."

The other drug U.S. forces can take to prevent malaria is the antibiotic doxycyline. Petrucelli said this drug is taken daily when in the region and can be started as late as a day or two before deploying and still reach adequate levels in the blood.

The likelihood of contracting malaria depends mostly on the level of individual protection, he said. "Going into the winter, the likelihood of malaria transmission is very low," he said. "However, there are some areas where transmission remains possible throughout the year."

One form of malaria found in Afghanistan, falciparum, is particularly deadly to individuals with no immunity built up. Immunity is gained by living for a long period in an area where malaria is present.

Americans have virtually no natural ability to fight malaria, but even those who have some aren't safe from contracting the disease. Their partial immunity would only help them survive a malarial bout, Petruccelli said.

In addition to taking preventive medication, it's important for service members to wear insect repellent, sleep under mosquito nets when possible, and have their uniforms treated with permethrin, an insecticidal chemical.

Personal protective measures aside, being physically fit and eating nutritiously are the best ways to fight illness, Petruccelli said. Fitness also makes it easier to acclimate to extremes of temperature and altitude.

"A person who is physically fit and well nourished has a much stronger immune system," he said. "Heat casualties are particularly notorious for someone who is not physically fit." That's because people who have to acclimate to heat and physical activity at the same time put much more stress on their bodies, he noted.

Local food and water should also be considered hazardous. Diarrheal illnesses, typhoid, hepatitis A and many other infectious diseases can be transmitted via food and water, Petruccelli said. Military members are vaccinated against typhoid and hepatitis A, but many other serious diseases can be contracted through infected food and water.

U.S. forces provide safe food and water sources for deployed service members, but the risk of food- and water- borne illness can be greater for special operations forces. These troops often travel in small groups on their own among local populations. Carrying large amounts of safe food and water is not usually possible.

Still, Petruccelli said, these troops can minimize their risks. He recommended service members with no options but locally produced food should avoid poorly cooked meat, dairy products and raw produce.

He explained there's a difference between a health risk and a threat. "A risk is everything out there that could possibly impact on someone's health," he said. A threat, on the other hand, is the likelihood of being affected by that risk even after you've taken personal protective measures into account, he said.

For more information on medical risks and staying healthy in Afghanistan, go to www.apgea.army.mil/deployment/stayinghealthy.asp.[link no longer available]